Pneumonia

Question 1

What is the most common organism identified in pneumonia?

Answer 1

Strep Pneumoniae

Question 2

What are some risk factors for legionella?

Answer 2

Chronic lung disease
Smoking
Diabetes
Immunosuppression
Steroids 
Malignancy
ESRF

Question 3

What population is haemophilus common in?

Answer 3

COPD patients

Question 4

What is the treatment for mild pneumonia?

Answer 4

Oral amoxycillin or doxycycline if penicillin allergy

Question 5

What is the treatment for moderate pneumonia?

Answer 5

penicillin (benpen or amoxicillin) + macrolide

Question 6

Severe pneumonia treatment?

Answer 6

Cephalosporin or betalactamase (augmentin) plus macrolide

Question 7

What are causes of atypical pneumonia?

Answer 7

Legionella
Mycoplasma
Chylamydia

Question 8

What is the definition of HAP?

Answer 8

pneumonia in someone hospitalised for greater then 48 hours or has been in hospital within the last 10 days

Question 9

What organisms are responsible for HAP?

Answer 9

aerobic gram negative bacilli
MRSA
ESBL
Pseudomonas
Acinetobacter
* atypicals very uncommon

Question 10

What are possible treatments of HAP?

Answer 10

Depends on risk of MDR
Low risk
mild - augmentin
severe - ceftriaxone with anerobic cover or Iv augmentin
High risk
Tazocin +/- gentamicin/vancomycin

Question 11

Micro of aspiration pneumonia?

Answer 11

Often sterile pneumonitis is most common feature early, may be followed by aspiration pneumonia
Strep pneumoniae still most common cause, anerobes occur but are overestimated

Question 12

When is metronidazole required for aspiration?

Answer 12

severe peridontal disease
alcoholic
abscess
empyema

Question 13

What is meliodosis?

Answer 13

Burkholderia pseudomallei pneumonia

Question 14

Where is meliodosis most commonly from?

Answer 14

Tropical areas - north queensland, northern territory, western australia
Peaks in the wet season

Question 15

Features of melidosis?

Answer 15

abscesses in spleen and prostate

localised cutaneous ulcers, encephalomyelitis

Question 16

Treatment for melidosis?

Answer 16

Carbapenem, ceftriaxone

Question 17

What is the mortality from pneumonia depending on severity?

Answer 17

managed in community less than 1%
managed in hospital 6-14%
ICU admission greater then 30%

Question 18

What is the time course for the resolution of pneumonia?

Answer 18

61% clear at 4 weeks
73% are clear at 6 weeks
slower if elderly, multilobar, bacteremia

Question 19

What are the most common causes of lung abscess?

Answer 19

Aspiraton - most common, anaerobic bacteria (peptostreptococcus, bacteroides)
Embolic source - from TV endocarditis, lemieres, staph aureus, pseudomonas, fusobacterium
Mycobacterium/fungi
Immunocompromised - Tb, norcardia, legionella, pseudomonas, aspergillus, cryptococcus
Healthy - staph aureus, klebsiella, entamoeba, strongyloides

Question 20

What is the empiric treatment for lung abcess?

Answer 20

need anerobic coverage - clindamycin, betalactamase or metronidazole plus penicillin